Title

Authors

Document Type

Critically Appraised Topic

Publication Date

2015

Clinical Scenario

The patient who led us to pursue this question is a 52 y/o female diagnosed with Multiple Sclerosis (MS). Physical therapy treatment to date has included balance training and strengthening programs for lower extremities and core musculature. The patient’s main functional complaint was an inability to keep up with family on walks. Contributing impairments to this functional limitation include balance deficits, decreased endurance, decreased strength, gait ataxia and decreased gait velocity.

Clinical Question

Does the use of Balance-Based Torso-Weight increase gait velocity in people diagnosed with Multiple Sclerosis?

Clinical Bottom Line

Based on outcome results from Gorgas et al., Widener et al. (October, 2009) and Widener et al. (April, 2009) we recommend a trial of BBTW for patients with MS who wish to improve gait velocity. Statistically significant improvements using the BBTW vest were recognized with an average gait velocity change by Gorgas, et al. (6.9 cm/sec) and Widener et al. (October, 2009) (10.1 cm/sec). Both gait velocities also met the clinically significant difference in gait velocity for patients with MS as suggested by Morris, et al. (2002). Widener et al. (April, 2009) did not find a difference in gait velocity between conditions. However, the number of subjects included in this study did not meet a sufficient power to determine a difference, even if one did exist. Gorgas, et al. found a small effect size and Widener, et al. (October 2009) found a small to medium effect size. Although this is not a large effect, for a patient population with MS, this could make a significant impact on quality of life and daily function. Even a small difference is important for populations with MS because fatigue is often the greatest limiting factor in daily life.

Validity of all studies in this analysis was good with only minor threats. Threats included lack blinding and multiple treatment interference. The vest cost is $795, which is a significant expense and may not be covered by insurance. It is feasible patients would pay this price if they experienced significant improvement in their gait velocity after a trial with the BBTW vest in clinic. The majority of study subjects were women which mirrors the established higher prevalence of women diagnosed with MS (Gorgas et al., 2014). Therefore, results can be confidently generalized to adult women diagnosed with MS. Caution should be taken when generalizing the results to men diagnosed with MS.

Research regarding the intervention of BBTW vests in populations diagnosed with MS is limited. There is a need for an increased body of research that encompasses more impairment based items such as balance, endurance and efficiency of gait. This could be done by using the following outcome measures: Berg balance scale, Dynamic Gait Index, Romberg, Timed Up and Go and motion analysis to assess efficiency of gait. Additionally, researchers should recruit subjects in lower functional base line status to determine the influence of the BBTW vest on gait velocity in this population. Dosage and longer term effects of BBTW usage would also be of interest for future research to better determine the intervention value.